915 Duodenojejunal Intussusception Caused by a Solitary Peutz-Jeghers-Type Polyp

Abstract

Abstract A solitary Peutz-Jeghers (SPJ) type polyp is a rare hamartomatous polyp that shares similar histological features to polyps found in typical Peutz-Jeghers syndrome (PJS), without the associated mucocutaneous pigmentation or family history. Intussusception is rare in adults and of the six previous reports of intussusception caused by a SPJ type polyp, only two occurred in adults. A 59-year-old female presented with recurrent episodes of colicky abdominal pain lasting a few hours. These episodes were followed by abdominal bloating and belching, but no vomiting. A CT scan of the abdomen and pelvis suggested intussusception of the fourth part of duodenum (D4) into the jejunum and a small bowel mass with D4 involvement. Physical examination did not reveal the associated signs of PJS. Multi-disciplinary team (MDT) recommendation was to resect the area in question. An exploratory laparotomy found a small bowel intussusception. Enterectomy of D4 and proximal jejunum was performed, with primary side to end anastomosis. Macroscopically, the specimen showed intussusception of the distal duodenum into the proximal jejunum, associated with a large duodenal polyp measuring 5×3 x 2 cm. microscopic examination revealed hamartomatous changes suggestive of a Peutz-Jeghers polyp. The resection margin showed normal small bowel tissue with no evidence of dysplasia. A colonoscopy to rule out additional polyps was negative, and the patient recovered well from surgery. This rare case highlights the non-specific presentation of intussusception, shows the need for methodical evaluation of the patient's history, examination, and investigations, and queries the requirement for surveillance and screening.